NEW YORK (Reuters Heath) - Ten percent of pediatricians say
they have seriously considered no longer providing vaccines due
to concerns about their cost, according to results from a 2011
survey.

That number is actually somewhat encouraging, said coauthor
Megan Lindley, from the Centers for Disease Control and
Prevention (CDC) in Atlanta.

"This echoes findings from a survey that CDC did four years
earlier in 2007," she said, and seeing that the 10 percent
figure has not gone up is a good sign.

"You never want to see that figure at all, but seeing that
it is not growing is encouraging," Lindley told Reuters Health.

If a pediatrician does decide to stop offering vaccines,
parents will have to take their children elsewhere to get shots.
Lindley stressed that the survey did not address whether doctors
had actually discontinued the vaccines, only if they had
considered it.

Newer vaccines like Gardasil for human papillomavirus (HPV)
tend to cost doctors more up front than older vaccines. That's
because bringing new vaccines to the market takes expensive
clinical trials and researchers have already developed the "low
hanging fruit" vaccines, Lindley said.

As of 2012, complete vaccinations through age 18 for one
child cost about $2,500, the authors write. Vaccines are given
during up to 35 separate appointments.

Private pediatric practices purchase these vaccines and are
reimbursed in two ways, once for the vaccine itself and once for
administration, by either private insurance or public insurance
like Medicaid. The amount doctors pay to buy vaccines and the
amount they are reimbursed can vary a great deal, the authors
note.

They asked 190 pediatricians and 181 family doctors about
their satisfaction with insurance reimbursements for buying and
administering vaccines.

A quarter of doctors responded "don't know" to both
questions and were not included in the results.

Among the rest, many were dissatisfied with insurance
payments for buying and administering vaccines. They were
equally dissatisfied with how public and private insurers
reimbursed the cost of vaccines themselves, but were more
dissatisfied with public insurers when it came to covering
vaccine administration.

For public programs Medicaid and the Children's Health
Insurance Program (CHIP), 21 percent and 18 percent of doctors,
respectively, said they were very dissatisfied with payments for
administration.

Doctors who were most dissatisfied with insurance payments
were often the same ones who had considered ending their vaccine
programs.

"The good news is that for parents, many of the problems
related to vaccine financing are being addressed by the
Affordable Care Act, which requires first dollar coverage -
meaning no copay - for all recommended vaccines for insured
patients (in non-grandfathered health plans, which is most of
them)," lead author Dr. Sean O'Leary told Reuters Health in an
email.

"The issue is if their child's doctor doesn't carry a
particular vaccine, it makes it that much harder to get their
child fully vaccinated," O'Leary, from Children's Hospital
Colorado in Aurora, said.

Parents with already busy schedules may end up having to
make two trips, one for the checkup and some of the vaccines and
another somewhere else to get the recommended vaccines their
doctor didn't carry, he said. Some parents might not make that
second trip, or might not have anywhere to go even if they
wanted to, he said.

"The bacteria and viruses that cause vaccine-preventable
diseases are still 'out there' in our society," Dr. David T.
Tayloe, Jr., founder of Goldsboro Pediatrics in North Carolina,
told Reuters Health. "Therefore, unimmunized children will be at
risk to contract vaccine preventable diseases."

If 10 percent of providers say they are considering no
longer offering childhood vaccines, that is concerning, Dr.
Walter A. Orenstein, associate director of the Emory Vaccine
Center in Atlanta, told Reuters Health. Neither he nor Tayloe
was involved in the new study.

"A real question is whether the responses given in the
survey, when it was conducted in 2011 reflect the current views
or whether those views are better or worse today than at the
time of the survey," Orenstein said.

Because the Affordable Care Act called for an increase in
Medicaid and CHIP vaccine reimbursement for at least 2013 and
2014, doctors might feel a bit better now than they did in 2011,
he said.

Some states purchase vaccines from manufacturers,
essentially providing them to doctors free of charge, but
putting this system in place in more states would be
"politically challenging," O'Leary said.

"Smaller scale fixes would be things like purchasing pools
for smaller practices so that they can negotiate the best price
for vaccines, and insurers working with practices and
professional organizations to provide timely and fair
reimbursement for vaccination," O'Leary said.

"Vaccination is incredibly valuable to our society - worth
far more than the present costs - and it would be great if
everyone, including insurers and policy makers, would start
considering not just the cost of vaccines in their
decision-making, but their value to society as well," he said.